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Dr Andrea Robertson is an Osteopath, Naturopath, and Nutritionist. Georgie Beames is a Psychologist and Coach. The information shared in this podcast is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your health regimen.

Show Notes

Episode Transcript

Episode 13 - What's Actually Happening to Your Body in Perimenopause - Functional Medicine Guide 

[00:00:00] I have had patients describe feeling like they were losing their mind when what they were actually experiencing was a hormonal transition nobody had prepared them for. -there's a term some people would now use called menowashing, bit like brainwashing, where the message gets shaped less by good evidence and more by whoever stands to sell you something.-

I don't want to say this to alarm you. I say it because I want you to understand that the habits you build during perimenopause are not simply symptom management for right now. They are a true investment in the woman you'll be at 60, 70, 80, and beyond.

Our sponsor today is Mineralite, an Australian electrolytes brand. And I have to tell you how I found them because this is a genuine story. Now, I'm really into paddle tennis, some may say obsessed , and a friend of mine introduced me to Mineralite to use for my hydration support during games. I was a little curious because I'd been recommending clients avoid those terrible sugary sports drinks for years, but I wasn't really sure what [00:01:00] other options were available.

I now know that Mineralite is the option I'll recommend. It's unflavored and contains no sugar, no sweeteners, no artificial colors, no nasty additives. Just clean electrolyte support in drops you can add to your water or any hot or cold drink. And my paddle? It was noticeably different. My energy held, my focus held, and I even won some games.

Mineralite is now in my water every single day. Go and check them out at mineralite.com.au or find them in most pharmacies and health food stores throughout Australia and New Zealand

If you have ever felt like your body simply changed the rules overnight, sleep that used to come easily, a temper that used to be steady, a waistline that used to respond to the things you always did, well, you're not imagining it.

And there is nothing medically wrong with you. Today I'm taking you through exactly what is happening underneath all the perimenopause symptoms you may be experiencing and what you can [00:02:00] actually do about them

I'm Dr. Andrea Robertson, osteopath, naturopath, and nutritionist. Here we nourish because food is medicine, and what you eat changes everything. We heal because the body has an extraordinary capacity to self-repair when we remove what's blocking it. And we rise because feeling well isn't the destination, it's the foundation for living the life you truly desire.

This is Nourish, Heal, and Rise

Before we begin, a quick and important note. Everything I share on this podcast is for educational purposes only. It's not personal medical advice, and it can't be, because in the context of this podcast, I don't know your health history, your medications, and what else is happening in your body. What I want this podcast to do is give you the knowledge to ask better questions, [00:03:00] understand your body more deeply, and make more informed decisions in partnerships with the practitioners who do know you.

If something resonates and you wanna take action, please work with a qualified healthcare provider who knows your full picture

Welcome back. Today, we're talking about perimenopause, and this topic has to be one of the most requested by you, my listeners, my community, and my friends. Perimenopause touches every woman in the world. There's no way around it. We can't escape it. Some women breeze through it without a second glance, and for others, it feels like nothing you've ever felt before.

So we're all going to experience it, whether you're in the thick of it right now in your 40s or watching things start to change in your late 30s or trying to understand what your sister, your colleague, or your own mother went through. I started talking about perimenopause around five years ago on my social media when I first started my online wellness programs, and at the time, no [00:04:00] one was talking about this online.

Thank goodness the narrative is changing. Though social media makes it all very confusing, with every little 30-second clip saying, "Eat more protein and lift heavy weights." I'm afraid it's a little more layered than that. Protein and exercise are part of it for sure, but not the whole picture. I'm glad now, though, that the narrative has moved on from either being dismissive, saying it's just part of getting older, or so medicalized it leaves you feeling like a set of symptoms rather than a, a whole complete person.

So I wanna give you the middle ground today, the actual biology explained properly and the functional medicine tools that work alongside it And I wanna name something else while we're here, because it definitely matters. As perimenopause and menopause have become more visible, they've also become more [00:05:00] profitable.

And there's a term some, I guess, some people would now use for that shift called menowashing, bit like brainwashing, where the message gets shaped less by good evidence and more by whoever stands to sell you something, whether that's a supplement company, a wellness brand, or, and I will say this too, some people exactly like me who are running online courses.

But it's definitely not me. I'm not menowashing you. I'm here for the facts and the stats and all the good stuff. First of all, I'll map out what we're covering today, so you know what is coming.

And we're gonna start with what perimenopause actually is hormonally, because many women are never taught this properly. Then we're going to run through the full symptom picture, because so many women miss the early signs because they don't know what to look out for. Then we're gonna look at the five systems perimenopause touches that often doesn't get connected in the same conversation: your hormones themselves, your blood sugar and insulin, [00:06:00] your gut, your histamine load, and your nervous system.

Then we're gonna move into what you can actually do about each of these with real, practical, food-first and lifestyle-first strategies. And then we're gonna finish with what this whole transition can look like when you are actually supported through it properly, rather than just gritting your teeth and getting through it.

Before we get into the biology, I wanna run through what perimenopause can actually look like, because this is where I think the biggest gap in public understanding sits. Most women are taught to look out for hot flashes and irregular periods, and that's about it.

And when their actual experience looks completely different to that, they assume something else entirely is wrong. The reality is that perimenopause can show up as a new anxiety that feels completely out of character. It can show up as a rage that [00:07:00] arrives disproportionate to whatever triggered it.

Then it leaves you wondering what that even was. It can also show up as brain fog so pronounced that you walk into a room and the next minute can't remember why. It can show up as joint aches that seem to move around your body from week to week, as new food sensitivities, as heart palpitations that send you to a cardiologist who finds absolutely nothing wrong, as itchy skin, as a burning tongue sensation, as vertigo, as complete loss of your usual resilience under stress, as itchy ears, which has been one of my symptoms, as frozen shoulder or plantar fasciitis or tennis elbow.

And for a lot of women, as vaginal dryness and discomfort, sometimes called the genitourinary syndrome of menopause, which almost nobody talks about openly, even though it's very, very common. I have had patients describe feeling like they were losing [00:08:00] their mind when what they were actually experiencing was a hormonal transition nobody had prepared them for.

Now, this matters because so many women, and so many of their doctors unfortunately, dismiss these symptoms individually. Blood tests come back as all normal, like, "You're, you're fine. There's nothing wrong with you." Thyroid levels look all normal, iron looks fine,

And the woman is sent away with no explanation when the actual explanation is that 80 to 90% of women experience symptoms through this transition. And those symptoms span across so many body and brain areas: mood, cognition, sleep, digestion, skin,

 joints, and the cardiovascular system, not just simply hot flushes and a change in your periods. So let's start with the basics, because I promise you, most women reach their 40s having never been taught this properly. I know if I wasn't [00:09:00] studying naturopathy and nutrition, I would never have been taught this.

I'm absolutely sure about that. So perimenopause is the transition leading up to menopause, and menopause itself is simply a point in time where you have gone 12 full months without a period. That's the definition of menopause. Perimenopause is everything before that, and it can run anywhere from two to 10 years or even longer.

For most women, it begins sometime in their 40s, although it can start earlier, and it ends on average in the early 50s. In Australia, the average age of menopause sits at 51, with a normal range anywhere from 45 to 55.

If your periods stop before 45, that's classified as early menopause, and before 40, that's called premature ovarian insufficiency, which can happen spontaneously all by itself or as a result of something like surgery, chemotherapy, [00:10:00] or radiotherapy. And here's a practical point I want you to actually hear because it catches women out constantly.

And here's the part almost nobody realizes at first.

Perimenopause is not a smooth, gradual decline of estrogen. I want you to let go of that image completely because it is so wrong, and it is the reason so many women feel confused by their own symptoms. Think of your hormones in your 20s and 30s like a rollercoaster running on a fixed track. The same climbs, the same dips, the same loops month after month, predictable enough that your body knows what is coming.

In perimenopause, the track changes underneath you. Estrogen does not steadily fall. It swings, sometimes spiking higher than it ever did in your 30s, then dropping sharply, often within the same month, like a rollercoaster that suddenly climbs higher than it ever has, only to plunge without warning.

Research following women through this transition using repeated [00:11:00] hormone testing has confirmed exactly this pattern.

Estradiol levels show real variance in both directions and magnitude across individual women, not just a neat downward slope. Then progesterone tells a slightly different story, and this is a piece I think is really underexplained. For a lot of women,

progesterone is actually the first hormone to shift, often years before estrogen becomes unpredictable.

So progesterone is produced after ovulation in what is called the luteal phase of your cycle. As ovulation becomes less consistent through your late thirties and into your forties, that luteal phase shortens, which means less progesterone is being produced even while your periods might still seem relatively regular.

Now, this creates a state that researchers describe as relative estrogen dominance. Not because estrogen itself is unusually high, but because [00:12:00] progesterone has quietly dropped out of balance with it. So it's high estrogen in relation to lower progesterone. When we have progesterone and when we have enough of it, it plays a lovely, calming role in the body.

It interacts with the same brain receptors as some anti-anxiety medications. So when it drops before estrogen does in perimenopause, that's when we can see anxiety, irritability, and disrupted sleep. And these are often the very first signs of perimenopause that a woman notices, sometimes years before even a single hot flush shows up.

Estrogen has its own direct relationship with your brain chemistry too. It shapes how well your serotonin and dopamine systems function, particularly in areas like your prefrontal cortex and hippocampus, which are heavily involved in mood, memory, and concentration. As estrogen becomes erratic, [00:13:00] that signaling becomes less reliable, which is part of why anxiety, irritability, low mood, and trouble concentrating so often cluster together during this transition rather than showing up as isolated, unrelated problems.

I do wanna give you an important piece of reassurance here. A review pulling together 12 separate long-term studies found no consistent evidence that perimenopause itself increases the risk of major depression for most women. So while mood symptoms are common, and they are hormonally driven, that doesn't mean depression is something you should expect as an inevitable part of this transition If what you're feeling goes beyond irritability and low mood and into something heavier and more persistent, that is worth a proper conversation with your GP, separate from everything else we're covering today

Meanwhile, [00:14:00] FSH, follicle-stimulating hormone, which is released by your brain to try to prompt your ovaries into action, it starts climbing. Think of FSH like a manager sending more and more emails to a team that is slowly winding down for the day. The emails increase in frequency and urgency precisely because the response on the other end is becoming less reliable.

Now, I'd love to share a story of one of my patients. I'll call her Renee for privacy reasons. Renee came to me at 42, absolutely certain that something was seriously wrong with her. Her periods were still fairly regular, so she assumed perimenopause could not possibly be relevant to her yet. But she had new anxiety that had never been part of her personality, and she was waking at 3:00 in the morning most nights,

And she also described feeling like her own skin was too tight. That was one of her symptoms. When we mapped her cycle [00:15:00] properly, her luteal phase, that second half of her cycle, had shortened considerably, a sign her progesterone production had already started declining well before her actual cycle length had shifted enough for her to notice.

Understanding that this was a hormonal problem, not a personality change or a mental health crisis out of nowhere, was itself part of her relief. Naming what is actually happening can really change how you experience it I also want to address something practical here because it does come up so often with the women I work with.

Blood tests for hormones during perimenopause are notoriously unreliable as a standalone diagnostic tool, and this trips up so many women who go looking for a number on the bit of paper from a blood test to confirm what they're kind of suspecting. Because your hormone levels are fluctuating so significantly during this time, sometimes within the same week, a single blood draw might land on a day where [00:16:00] estrogen happens to be unusually high, giving a completely misleading snapshot.

And this is exactly why perimenopause is generally considered a clinical diagnosis built from your symptom history and patterns rather than just a single lab test. So if you've gone looking for confirmation through blood work, which I see it time and time again, I have patients come to me and beautiful women say, "Oh, my doctor says I'm not in perimenopause," and here they are at forty-seven.

And I'm like, "Well, you've got a lot of symptoms. Of course, you're in perimenopause. It doesn't have to show up on the blood test." So even if you had confirmation through the blood work and you've been told everything looks normal, that does not mean nothing is happening. It often just means you tested on a day when the pendulum happened to be swinging the other way, or the rollercoaster was on the straight cruising part.

It's also worth understanding that perimenopause itself is not one uniform experience across its whole span of perimenopause. [00:17:00] Researchers typically describe an early phase where cycles are relatively regular, but subtle shifts like the short and luteal phase we've just discussed are already underway.

And then a late phase, closer to menopause itself, where cycle length starts to become unpredictable. Periods may be skipped entirely for months, and vasomotor symptoms, that's your hot flushes, well, they tend to intensify in that later stage. Knowing roughly where you sit in that spectrum can help to make sense of why your symptoms might be evolving over time rather than just staying static.

I also want to mention testosterone briefly because estrogen and progesterone get almost all of the air time, and testosterone also deserves a place in this conversation

Testosterone in women is produced by both the ovaries and with support from the adrenal glands, and it tends to decline more gradually across your 30s and 40s than the sharper, more erratic shifts we see [00:18:00] in estrogen and progesterone. But by the time you reach perimenopause, the cumulative effect of that gradual decline often becomes noticeable, showing up as reduced libido, lower muscle tone despite consistent training, and a drop in the kind of drive and motivation many women describe as previously effortless.

This is one of the reasons resistance training carries so much weight through this transition. So all of those social media posts saying, "Lift heavier weights," well, it's true. It's not the only thing, but it is true. And that heavy weight lifting is not only important for blood sugar regulation, which we'll get to shortly, but because it is one of the few tools that really supports your body's ability to maintain muscle and strength even as testosterone itself is declining Now, we've done the hormones.

We've covered the biology of perimenopause. So I wanna go through a bit more biology, and I wanna go through the five systems that [00:19:00] perimenopause touches. This is where I wanna bring in the functional medicine lens properly, because perimenopause is never just a hormone story. It's a whole body story, and five systems, in particular, deserve your attention.

System number one is your blood sugar and insulin. Estrogen plays a direct, active role in how sensitive your cells are to insulin. Insulin is that hormone that shuttles glucose out of your bloodstream and into your cells for energy. And as estrogen wobbles up and down and eventually declines through perimenopause, insulin sensitivity worsens.

Research comparing post-menopausal women to pre-menopausal women has found higher fasting blood glucose and considerably larger glucose spikes after meals in the post-menopausal group. And the transition through perimenopause is where this shift begins. Think of insulin [00:20:00] like a key and the insulin receptors on your cells like locks.

In your 30s, that key slides into the lock smoothly. As estrogen becomes unpredictable through perimenopause, those locks start to rust slightly. The key still works, but it takes, urgh, more force, more insulin, to get the same result. And your pancreas responds by producing more insulin to compensate, and higher circulating insulin makes it considerably harder for your body to access stored fat for energy, which is a real physiological reason so many women notice fat redistributing towards the midsection during this transition, even without any change to their diet or exercise routine.

This is also, not coincidentally, why sugar and carbohydrate cravings often intensify during perimenopause. A dip in blood glucose triggers a strong physiological pull towards wanting to eat [00:21:00] fast-digesting carbohydrates.

It's like your body's attempt to correct that blood sugar dip quickly. And this becomes a self-reinforcing cycle if it's not addressed properly with what and when you eat, which we will come to later in this episode There is another layer to this worth understanding because it explains a symptom cluster that often confuses a lot of women.

Some of the shakiness, the sudden wired feeling, or the irritability that shows up an hour or two after eating, particularly after a carbohydrate-heavy meal. It's not simply hormones in the vague sense that women are told. It can be a genuine blood sugar swing, made considerably more pronounced by the same hormonal shifts we've been discussing already today.

Interestingly, research using continuous glucose monitors has found that women reporting more frequent hot flushes also show greater variability in their [00:22:00] blood glucose readings, which suggests that these two seemingly unrelated symptoms of temperature regulation and glucose control may actually share common hormonal drivers rather than being two entirely separate problems.

Now, I had a client go through my 12-week Whole Health Solution program who described this pattern almost exactly. She would eat what she considered a completely normal lunch, a sandwich and some fruit, and by 3:00 p.m. she was shaky, grumpy, irritable, and reaching for something sweet without even registering the decision.

When we restructured her lunch around protein first, adding eggs or chicken alongside the same sandwich rather than instead of it, that entire 3:00 p.m. crash disappeared within about a week. Nothing else in her routine changed.

That one shift in macronutrient balance, the balance between her carbs, proteins, and fat was the entire fix Now, the second system that perimenopause touches [00:23:00] is your gut microbiome. This is a piece of the puzzle that rarely gets airtime. I mean, it's starting to get more airtime, but I think we need to give it more attention than it's already getting.

Now there is a specific collection of gut bacteria called the estrobolome that plays a direct role in how your body processes and recirculates estrogen. These bacteria produce an enzyme that reactivates estrogen that would otherwise be excreted through the gut, essentially determining how much estrogen continues recirculating in your bloodstream versus how much leaves your body altogether Think of your gut like a recycling depot for hormones.

When the gut's functioning well, it sorts and it processes efficiently. When gut diversity is reduced, which is a well-documented pattern through the menopause and perimenopause transition, this recycling process becomes far less efficient, and that inefficiency can [00:24:00] compound the hormonal instability you are already experiencing from your ovaries directly.

On the flip side of the gut microbiome affecting estrogen, there's actually a two-way relationship here, and it's worth understanding because it explains why digestive symptoms so often change noticeably right alongside other perimenopause symptoms rather than being some unrelated coincidence of aging.

Estrogen itself helps maintain the integrity of your gut lining, and it supports microbial diversity. So as estrogen becomes erratic, the gut can become more permeable, which is called increased intestinal permeability, or otherwise known as leaky gut. And this allows particles through the gut wall that would normally stay contained inside of the gut lumen, the gut tract.

When it goes through, well, it triggers more of the very inflammation we're about to discuss as our third system, that chronic inflammation. This is precisely why [00:25:00] so many women notice new bloating, new food sensitivities, or a digestive system that suddenly reacts to foods it never used to react to right alongside their first perimenopause symptoms.

The gut and the ovaries are not operating in isolation from each other. They are in constant conversation. Which brings us to the third system affected by perimenopause, and this is one I talk about a lot because I have been known to be called the queen of inflammation. So that is inflammation, chronic systemic metabolic inflammation.

If you wanna know more about inflammation, please go back and listen to the first part of this podcast. I did an eight-part series on the eight most common signs of inflammation. Now, estrogen has a protective anti-inflammatory effect throughout your body. And as it wobbles in perimenopause, that protective effect becomes less reliable.

And levels of inflammatory markers called cytokines, the chemical messages your immune system produces when it's activated, well, they tend to rise. [00:26:00] This inflammation is part of what is now understood to contribute to the mood changes so many women experience in perimenopause. It's not simply just hormones, but hormones acting through inflammatory pathways can affect brain chemistry and neural circuits involved in emotional regulation as well So think of inflammatory cytokines like static building up on a radio signal.

The station, meaning your mood, your brain function, your emotional resilience, it's still broadcasting exactly as it always did, but the static is making it much harder to hear clearly. The same inflammatory shift is almost certainly behind the joint aches so many women describe during perimenopause, sometimes called menopause arthritis or the musculoskeletal syndrome of menopause,

and this shows up even in women with no history of joint problems in the past whatsoever. Estrogen has a direct protective effect on joint cartilage and connective tissue, so as it becomes erratic with those [00:27:00] wobbles of estrogen, joints that were never a problem before can suddenly ache, particularly first thing in the morning.

And inflammation is also part of why your skin changes. Increased dryness, reduced elasticity, and slower wound healing. Well, they all tend to accelerate through this window as well, since estrogen supports collagen production throughout your body, not only in your reproductive tissue. And inflammation is also a driver for brain fog, weight gain, and fatigue, all symptoms that can worsen with perimenopause

Now I wanna go a little deeper on the fourth system, because this is the one that is new information to many people, and it is deeply connected to everything we have covered so far. And this is your histamine load. Most women have never heard the word histamine outside of hay fever season or an antihistamine tablet or a bee sting maybe.

But histamine is a chemical messenger your body uses constantly. And in perimenopause, it becomes a [00:28:00] very different story to the rest of your life. So here's the mechanism. Estrogen stimulates the cells that store and release histamine, called mast cells, to release more of it. At the same time, estrogen suppresses the main enzyme responsible for breaking histamine down, called diamine oxidase or DAO, D-A-O.

Progesterone does the opposite. It helps produce DAO, and it has a calming, stabilizing effect on those same mast cells. Think of DAO like the drain in your bathroom sink and histamine like the water running from the tap. In your 20s and 30s, with progesterone cycling normally, that drain stays reasonably clear.

So however much histamine comes in, it clears out at roughly the same rate. In perimenopause, progesterone drops away first, often years before estrogen becomes erratic. So the drain gets partially [00:29:00] blocked. Then estrogen spikes on top of that blockage, turning the tap on harder at the exact moment the drain is least able to cope.

Histamine backs up. And to make it worse, histamine itself then stimulates your ovaries to release more estrogen. So the whole thing can become a really genuine feedback loop, each side making the other more reactive This is precisely why so many women who have never had an issue with food sensitivities suddenly find themselves reacting to wine, aged cheese, chocolate, leftovers, or fermented foods for the first time in their 40s.

It is not that their body has suddenly turned against them. It's the drain has slowed down the clearing Now, I wanna share my own experience with this because it took me quite a while to connect the dots. In perimenopause, it's probably about three years ago from now, maybe two, I started getting migraines, and I mean properly flattened by them.

The kind where you can't function, can't [00:30:00] think, can't do anything except put your sunglasses on and lie down in a dark room waiting for it to end. I have never had migraines like this before, and I could not work out what was triggering them. The pattern that eventually gave it away was chocolate. I would have some on a weekend, nothing that felt excessive, and then on the Monday, like clockwork, a migraine would hit.

It took me a while to put it all together because two days had passed. It wasn't like I ate something one day and then the next day I got symptoms. It was two days. So my mind wasn't immediately connecting Saturday's chocolate to Monday's migraine. But once I started tracking it properly, the pattern was undeniable, very sadly.

And once I looked into it, chocolate is one of those foods that is very high in histamine-releasing compounds. So even though it's very sad, it does make sense. Since then, and since learning this about my body, I keep my histamine load very low. I don't cut out histamine foods completely.

I just keep the load low, and this, thank goodness, keeps me migraine-free [00:31:00] most of the time. Sometimes I eat too many histamine foods, and then I get a headache or a migraine. It's crazy how it's so-- The cause and effect is really obvious and really there. But I have learned to read my own early warning signs.

If I've had a bit too many histamine foods over a few days, I don't go straight to a migraine now most of the time. Instead, I get a postnasal drip first. It feels like something's running down the back of my throat, and a bit of head congestion, almost like the beginning of a cold that actually never turns into one.

That is now my warning sign to pull back on the histamine foods before it escalates any further. Learning your own early warning signs, whatever they happen to be for you, is one of the most useful tools you can build for yourself, and that's something I have great pleasure in teaching the women inside of my 12-week programs how to do.

The symptom picture for histamine intolerance overlaps enormously with perimenopause itself, which is exactly why it goes under the radar so much. Headaches and [00:32:00] migraines, hives or itchy skin, flushing, a racing heart, and disrupted sleep can all be histamine-driven, hormonal-driven, or both at once.

And if your symptoms seem to worsen specifically around ovulation or in the days before your period when estrogen tends to peak, that is a clue worth paying attention to Then we come to the fifth system that perimenopause touches, and that is your nervous system and cortisol. As progesterone and estrogen become less reliable, cortisone, your primary stress hormone, tends to trend upward through the perimenopause years.

This is not simply about how stressed you feel day to day. It is a measurable physiological shift, and it compounds the insulin resistance we already talked about, because cortisol itself promotes glucose release into your bloodstream, adding another layer of difficulty on top of hormones that are already asking more of your metabolism.

Your nervous system does not treat these [00:33:00] shifts as separate problems one after another. Cortisol, blood sugar, histamine, and mood regulation all move together because they were never actually separate systems to begin with. This is exactly the pattern I now see playing out in my perimenopausal clients every single week.

When we support one system properly, the others all tend to settle alongside it

I wanna spend a moment on why perimenopause deserves your attention beyond simply feeling better from week to week, because there are longer-term stakes at play here that rarely get mentioned in the same breath as hot flushes and mood swings. You may have heard that estrogen has a protective effect on your bones, and as it declines through perimenopause and beyond, bone density loss accelerates, sometimes beginning as early as your early 40s, well before menopause itself.

And so many girls are shocked when they get a, maybe a scan and they find out that [00:34:00] they've got early-stage osteoporosis called osteopenia in their 40s. So it's exactly why building your calcium, your vitamin D, and your resistance training habits now during perimenopause matters so much more than waiting until you get a bone density scan that gives you a fright in your 60s.

My mom is an osteoporosis sufferer. Hers came about after having breast cancer when she was in her late 30s, having very strong chemotherapy back then, developing multiple chemical sensitivities and not being able to take osteoporosis medications because she had these terrible allergic reactions that nearly killed her.

So my mom is, uh, you know, suffering now from osteoporosis, and I see the effects of that on her every single day, so it's something I don't want for myself at all. So I decided to get a bone density, a DEXA scan done, uh, probably about 18 months ago, and then I... It was fine, which was great, but then I really went hard at the gym probably three, two [00:35:00] to three times a week, learning how to do progressive overload.

And 18 months later, I had another bone density scan, and voila, my bone density had not gone backwards, but in fact it had actually improved. So it just shows how much and how important resistance-based training is for us girls in this age group. I'm thinking of another friend of mine now. We caught up recently when she was visiting Melbourne, and she told me, age 49, she had a scan saying she was osteopenic,

So it's more common than you think, and it just shows, I don't know, I keep going on about it, but please do some weight-based exercise, girls. Jump, lift heavy weights, do the things. It's so important.

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Estrogen offers a protective effect on your blood vessels and your cholesterol profile, and as estrogen declines, that protection reduces.

This is part of why heart disease risk in women rises more steeply after menopause than before it, and why the blood sugar and inflammation work we've discussed today is not about how you feel this month, but about the trajectory you're setting for the decades that follow for your long-term best health.

There's also a cognitive piece worth mentioning here, because brain fog isn't only a today problem. Researchers have identified a set of modifiable risk factors for dementia later in life, and several of [00:37:00] them sit squarely inside what we're already talking about. Physiological stress, heavy alcohol use, and elevated homocysteine,

which is a marker that responds well to B vitamins and is something that I test in all of my clients. None of this is about scaring you. It's about recognizing that the choices available to you right now in your 40s and 50s are doing double duty, supporting how you feel today and protecting how you think and function decades from now.

I don't want to say this to alarm you. I say it because I want you to understand that the habits you build during perimenopause are not simply symptom management for right now. They are a true investment in the woman you'll be at 60, 70, 80, and beyond. And this is precisely the long-term view I hold with every client who comes through my 12-week program.

Because the work you do today in your 40s and 50s is quietly determining how well you move, think, and feel for the rest of your life Before we get into [00:38:00] what to actually do if you're experiencing perimenopause symptoms, I want to address three false myths I hear commonly, because these incorrect myths often lead women down the wrong path entirely.

So myth number one: perimenopause only starts in your late 40s or 50s. Now, for some women, that's true,

But it is entirely normal for the earliest hormonal shifts, particularly that shortening luteal phase we already discussed, to begin in your late 30s or early 40s, years before a single hot flash shows up. If you're in your late 30s, reading your symptoms

against a checklist built for a 55-year-old, you may be dismissing what's actually happening to you right now. Now, myth number two: if your periods are still regular, you can't be in perimenopause. Wrong. This is one of the most common misunderstandings I encounter in clinic, and Renee's story that we talked about earlier is a perfect example of why.[00:39:00] 

Progesterone can decline substantially, causing real symptoms, while your cycle length itself still looks completely normal on the surface. Regular periods tell you ovulation is still occurring reasonably consistently. They do not tell you anything about how much progesterone that ovulation actually produced.

Then myth number three: this is just something to push through, and nothing can really help until it's over. Again, wrong, and I understand exactly why this belief exists, because so many women are told this by the very practitioners they turn to for help. But everything we've discussed today, your blood sugar, your gut, your chronic inflammation, your histamine load, and your nervous system, all of that is really responsive to the right support.

This does not mean every symptom disappears entirely. It means the severity, the frequency, and your capacity [00:40:00] to cope with what remains can shift a lot when these five systems are properly supported, rather than left to compound each other unchecked. Okay, so let's go on to what you can actually do about perimenopause symptoms, and I wanna give you real, specific, actionable strategies for each of those five symptoms, because understanding the mechanism only matters if it changes what you do on any given day of the week.

For your blood sugar and insulin sensitivity, number one is to base every meal around protein first. So 25 to 30 grams at breakfast is the target I give most clients, because a protein-rich breakfast blunts those blood sugar swings That would otherwise go up and down then throughout your entire day.

Number two, take a walk after meals if you possibly can. Even 10 minutes of walking after eating improves how efficiently your muscles take up [00:41:00] glucose, directly reducing the insulin spike that follows a meal. Number three, resistance training. I know I'm harping on about this, but resistance training becomes considerably more important through the perimenopause transition, not simply for muscle tone and looking good, but because muscle tissue is one of the primary sites where glucose gets stored.

More muscle mass means better blood sugar regulation. So two to three sessions a week focused on real progressive overload is what I recommend, and this is precisely why movement is built into my programs as thoroughly as the nutrition side is, and mindset too. That's just as important.

Number four, pay attention to the order you eat things within a meal, not just what's on the plate. Eating vegetables and protein before you eat the carbohydrate portion of a meal, rather than mixing everything together from the first bite, actually reduces the glucose spike that follows purely through sequencing, and this costs you [00:42:00] nothing, and it takes no extra time.

It is simply a different order of eating food at the same table. Now, for your gut microbiome, fiber diversity matters more than fiber quantity alone. So I've said it before, and I'll say it 100 times again, aim for 30 different plant foods across your week. Vegetables, legumes, herbs, nuts, seeds, grains all count towards this.

30 foods in a week, it does sound like a lot until you realize how quickly herbs and spices can add up. And eat cruciferous vegetables specifically. Broccoli, cauliflower, Brussels sprouts, kale, cabbage, bok choy. This family of veggies contains compounds that support healthy estrogen metabolism pathways in the liver, working alongside your gut to help process hormones efficiently.

One cup of those foods most days is a great goal to aim for Then fermented foods are great for your gut. Sauerkraut, kimchi, [00:43:00] kefir if dairy suits you, or coconut yogurt if it doesn't. Well, these support the overall bacterial diversity that underpins healthy hormone recycling. A quick note here though, and we'll come back to this under histamine.

Fermented foods are also naturally high in histamine, so if you suspect histamine is part of your picture, this is one to introduce as very small amounts carefully rather than all at once. And lastly, for the gut, if you've noticed new bloating or new food reactions creeping in, it's worth having an honest look at whether gluten and dairy specifically are contributing, since both are very common gut irritants that can widen an already more permeable gut lining during this transition.

And this is exactly the elimination approach I built my three-week inflammation detox diet around, not as a permanent restriction, but as a genuine reset to see what settles once the common irritants are removed.

Now, for inflammation. [00:44:00] As I said earlier, if you'd like to know more about inflammation and haven't yet listened to the eight-part series that I launched this podcast with, go back and have a listen. I shared the eight most common signs caused by chronic inflammation and what to do about it. And really, the place to start is with finding the right anti-inflammatory nutrition approach for you.

Not the one your friend has or not someone off Instagram, but the one that works for you. This is what I do with my clients in my 12-week program, and also in a more simple way in the three-week inflammation detox diet, and it's why my programs are so relevant in perimenopause and menopause. We look at removing the foods that add to your inflammatory load.

Gluten and dairy are the two most common culprits I see, along with sugar, alcohol, and ultra-processed foods. And cutting these out for a while, it frees up your body's resources to manage the inflammation your hormones are already generating, rather than fighting a battle on two fronts at once.

So keep [00:45:00] a check on gluten, cow's dairy or any dairy, added sugar, and ultra-processed food intake. Not from a place of restriction for its own sake, but just because gluten and dairy in some people, and sugar and ultra-processed food in most people, are well-established drivers of the same inflammatory pathways we've been discussing

This is not about perfection. It's about recognizing that every plate is either adding to your inflammatory load or helping calm it. And most days, most plates moving in the calmer direction is what actually matters over months and years

I'd love you to also prioritize colorful plant foods, berries, leafy greens, and pomegranate specifically have reasonable evidence behind the anti-inflammatory effects of their polyphenols, their plant chemicals. And add omega-3 fatty acids from oily fish two to three times a week or a quality fish oil supplement if that's not realistic for you.

This also helps modulate the inflammatory response. [00:46:00] Now, let's talk about what we can do about our histamine load. So I want you to get familiar with the highest histamine foods, even if you don't eliminate them entirely, which is aged cheese, cured and processed meats, wine and champagne, fermented foods, and leftovers that are more than a day or so old.

Eggs are in there too, unfortunately. Yeast and sourdough as well, and yes, chocolate and cacao. Sadly, the avocado and tomato and eggplant is also included, plus some beautiful favorite fruits of mine, citrus and kiwi fruit and strawberries, so sad, and raspberries. Now, you don't need to remove all of these forever.

Some of you may just need to reduce the load. Then I would suggest for you to keep a simple system and food log for two to three weeks. Migraines, hot flushes, hives, congestion, a racing heart

Or disrupted sleep that shows up hours to a [00:47:00] day or two after eating is the pattern to look for, since histamine reactions are often delayed rather than immediate, which is exactly why so many women get so confused about it and miss the connection completely. It's a great idea if you have histamine intolerance that you can support your own DAO capacity.

Remember that DAO enzyme, diamine oxidase, that helps break down your histamine foods in the gut? Well, vitamin C, vitamin B6, and copper are all cofactors your body uses to produce this enzyme. So a nutrient-dense diet supports histamine clearance from the inside. A DAO supplement, which you can get these days, taken before a higher histamine meal is also an option worth discussing with your practitioner if your reactions are significant

Then prioritize fresh food over leftovers where you can. You just don't wanna have leftovers that are been in the fridge for more than three to four days. This is because histamine levels in [00:48:00] food climbs the longer it sits in the fridge. Freezing food immediately after cooking rather than refrigerating it for a few days keeps that histamine levels considerably lower too, which is good to know.

And then learn your own warning signs the way I learnt mine. For me, as I said, it's the postnasal drip and a bit of head congestion before anything worse arrives. For you, it might be something else entirely. That early signal, whatever it is, is worth listening to before it escalates. Now let's go on to what to do to support your nervous system and cortisol through perimenopause and menopause.

Magnesium is magic here. Well, maybe not quite magic, but magnesium is great. I've seen it make some really positive changes in many women who I've worked with. There's a research paper I wanna mention here. A 12-week supplementation study specifically in perimenopausal women found improvements in sleep quality, cognition, and psychological wellbeing after taking magnesium.[00:49:00] 

Magnesium glycinate taken in the evening is the form I recommend most often because it is well-absorbed and specifically supportive of sleep. Then protect your morning light exposure and your evening light reduction. This sounds almost too simple to matter, but circadian rhythm regulation directly influences cortisol's daily pattern, and a disrupted rhythm is one of the most common and most easily fixable contributors to the wired but tired feeling so many perimenopausal women describe

Now rest is so, so important, and I want to be very clear about this because it matters more than any supplement I could recommend. Your nervous system needs genuine downtime, not just sleep, but actual unstructured recovery. We all need to factor in true rest. Next, you might not [00:50:00] like me for this one, but it is time to be honest with yourself about your caffeine and alcohol intake during perimenopause and menopause.

Because both of these, caffeine and alcohol, place additional demands on an already taxed HPA axis. So you might remember from previous episodes that your HPA axis is your three stress organs, the hypothalamus and pituitary in the brain, and your adrenals that sit just above the kidneys. And alcohol and coffee can have a negative effect on how these function.

On the note of alcohol, wine specifically also carries a histamine load on top of that. So for some of you, that's a double reason to avoid it. Now, I'd love-- my wish list, what I'd love for all of you is that you all eliminated alcohol through this life stage. It's a hepatotoxin, which means it's a liver toxin, and it's not helpful to you during this time that your liver is already working so hard on adjusting to hormonal changes as it is.[00:51:00] 

I know that's very hard. I know it's hard. So if you feel like you can't cut those out for a while, really start noticing whether your afternoon coffee or your regular glass of wine is quietly working against the calm that you're aiming for, and that might make it easier for you to reduce it or cut it out.

Then make sure you add in movement that also calms rather than stresses your nervous system or, or only challenges it. So alongside your resistance training, build in something with a lovely regulating effect on your nervous system. Walking outdoors, gentle stretching, breathwork, padel like I do, whatever version of this actually appeals to you.

The goal through perimenopause is not simply more exercise, it is the right balance of exercise that builds you up, like resistance training alongside movement that settles your nervous system back down

Before we move on to the next thing, I wanna give you a quick, [00:52:00] honest rundown of where the evidence actually sits for some of the herbal and nutrient supports you probably already learnt about, because I know a lot of you are already researching and reaching for these.

In one large Australian survey of women in their late 50s and early 60s, 39% of women had consulted a complementary medicine practitioner for menopause symptoms, and 75% had self-prescribed something themselves. So you are absolutely not alone in wanting options beyond or alongside conventional medicine.

For hot flashes specifically, black cohosh has the strongest evidence base of anything in this space. A meta-analysis pulling data from over 40,000 women found it performed significantly better than placebo, with efficacy comparable to low-dose transdermal estrogen in some studies, and showed no signal of liver toxicity despite some outdated concerns maybe you've heard about.

Red clover is another reasonable option, particularly at high doses of [00:53:00] 80 milligrams a day or more, and it may also help lower LDL cholesterol, that's kind of your bad ones, along the way. For sleep, alongside the magnesium I have already mentioned, valerian and lemon balm

Both have reasonable trial evidence in post-menopausal women, and something as simple as lavender oil inhalation before bed has shown benefit too. For mood, saffron extract has good trial evidence for perimenopausal symptoms specifically. Ashwagandha or Withania also has support here too, but I wanna flag something important.

Australia's Therapeutic Goods Administration issued a safety advisory in 2024 around ashwagandha and the potential for gastrointestinal symptoms, and so it should be avoided also if you've had any history of liver problems. As always, always, always, always run any new supplement past your practitioner who knows your full case and your full story, particularly if you're on other medications such as St. John's wort in [00:54:00] particular, because it interacts with a long list of prescription drugs. And if vaginal dryness is part of your picture, which so many women don't mention because it feels embarrassing to bring it up, eating 25 grams of freshly ground flaxseed daily has some trial evidence for improving vaginal tissue health.

You can make it into muffins or bread. I have a really great recipe in my recipe book that I call No Egg Paleo Bread, which has lots of ground flaxseeds in it

Now, none of this replaces a conversation with your practitioner, but if you want a reliable starting point, the Australasian Menopause Society has consumer facts sheets that grade the evidence and safety of complementary medicine options , with a simple traffic light system.

So it's a nice place to start if you're looking for some supplements to help yourself. I'll always encourage you to bring that list into a conversation with whoever it is supporting you through this too. I wanna give you one more tool before we move into today's summary, because I think it is really underused.[00:55:00] 

Given how much perimenopause fluctuates and how unreliable a single blood test can be, tracking your own symptoms over two to three months is one of the most valuable things you can do, both for your own understanding and for any conversation you have with a practitioner.

Something as simple as a note on your phone each day, like your mood, your sleep, any hot flashes or night sweats, where you're at in your cycle, and yes, what you ate the day or two before a symptom flared, well, that builds a pattern that a single snapshot never could. When you bring that pattern into a consultation rather than simply saying, "I've been feeling off," or, "I don't feel like myself," well, when you've got that data, you give your practitioner something super useful to work with, and you often notice the pattern yourself before anyone else even needs to point it out.

And if you do take this into a conversation with your GP or a specialist, I want to encourage you to advocate for yourself clearly. Describe the specific pattern you've tracked. Ask [00:56:00] directly whether perimenopause could be a contributing factor. And if you feel dismissed without a genuine discussion of your actual symptom pattern, it is entirely reasonable to seek a second opinion from a practitioner who takes this transition seriously.

You know your own body's baseline better than anyone else in the room, so stand up for yourself, you beautiful woman. Now, let's bring today's five systems and their solutions together. Blood sugar and insulin. Make sure you have protein-focused meals. Do some walking after you eat and resistance training two to three times a week.

For your gut microbiome, 30 different plant foods a week. Have daily cruciferous vegetables and fermented foods introduced carefully. For inflammation, omega-3s and an anti-inflammatory nutrition foundation full of colorful polyphenol-rich foods. For your histamine load, know your highest [00:57:00] histamine foods.

Track any delayed reactions and support your DAO production with vitamin C, B6 and copper, and favor fresh foods over leftovers. And nervous system and cortisol. Take magnesium glycinate in the evening, protecting your light exposure rhythm and genuine, true scheduled rest. And for hot flushes, sleep, mood and vaginal discomfort, targeted herbal and nutrient options chosen carefully with your practitioner.

I want to finish with what this transition can actually look like, because I think it's the piece missing from almost every conversation around perimenopause. This transition is not something to simply survive with your teeth gritted until it's over.

When you understand what is actually happening across these five systems, and you support each one deliberately, this can be a period of genuine recalibration rather than pure decline. I have watched women I work with move [00:58:00] from feeling like their body has started to turn against them to feeling like they finally understood the instructions they'd never been given.

That shift alone, understanding, replacing confusion, changes how this entire decade of your life feels, regardless of exactly where your hormone levels sit on any given week

Now, I wanna bring my client Renee back into the conversation because her story didn't end with simply naming what was happening to her. Over about four months, working through her meals with a protein-first structure, adding cruciferous vegetables and fermented foods into her week, and really committing to magnesium and a wind-down routine in the evenings.

Well, her 3:00 AM wake-ups became the exception rather than the rule. Her anxiety didn't vanish entirely, but the intensity definitely dropped enough that she described feeling like herself again for the first time in over a year That is what this looks like when it works. Not always the [00:59:00] disappearance of every symptom, though it can happen, but a real return of capacity, resilience, and the sense that your own body is on your side again.

I also wanna say plainly that food and lifestyle changes are not the only tool available to you, and functional medicine does not mean rejecting medical support. For some women, hormone therapy is an appropriate and evidence-supported option, and that conversation belongs with a qualified practitioner who knows your full history, not with me here on a podcast.

What I want you to take from today is that the five systems we've covered, your blood sugar, your gut, your inflammation, your histamine load, and your nervous system, are worth supporting regardless of whether medical intervention is also part of your picture. These are not competing approaches. They work alongside each other beautifully.

If today's episode resonated with where you're at right now, this is the exact territory my 12-week program was built for, because perimenopause rarely [01:00:00] responds to a single change in isolation. It responds to all five systems being addressed together consistently over months rather than weeks or days.

Now, next week on the podcast, We have a listener questions episode for you. We're gonna have a question about calcium in your mid-40s if you don't eat dairy. Then we address coffee, the best time to drink it, whether to have it before or after exercise, and whether black coffee can actually constipate you.

Then we're gonna move into a question about managing your meals when you're traveling. It's such a common problem. How do we keep healthy when we're traveling? And then we will wrap up next week's episode with a question about beating sugar and carb cravings when you're feeling tired and bored.

So please hit subscribe or follow the show on whatever platform you are listening on right now, because you do not wanna miss a single episode. And if someone in your life needs to hear this, please share it with them too, because the more women who have access to this kind of information, the better.

Just a little note, all of my free resources, my three-week [01:01:00] inflammation detox, and my 12-week whole health solution can be found at andrearobertson.health. Everything you need is right there waiting for you. If you loved today's episode, please take 30 seconds to leave a review on Apple Podcasts, Spotify, YouTube, or wherever you listen to your podcasts.

It genuinely helps more women find the show so they can nourish, heal, and rise too. Until next week, nourish your body, keep healing, and never stop rising. I'm Dr. Andrea Robertson, and this has been Nourish, Heal, and Rise.

 

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